bridging the social gap & connecting cultures

Lisa Hoang, LMHCLisa Hoang, LMHC

Rose Augustine, MARose Augustine, MA

Pasadena Villa Network of ServicesPasadena Villa Network of Services

�

The “Stuff” People Say...

Cultural Awareness Preparing for Discovery

�� Purpose

� Cultural Awareness is the foundation of communication and it involves the ability of standing back from ourselves and becoming aware of our

Cultural Awareness

back from ourselves and becoming aware of our cultural values, beliefs and perceptions. Why do we do things in that way? How do we see the world? Why do we react in that particular way? (Stephanie Quappe &Giovanne Cantatore, 2005)

� Cultural awareness becomes central when we have to interact with people from other cultures.

Aspergers – Innate Culture

��Culture: "any group of people who identify or

associate with one another on the basis of some common purpose, need, or similarity of background" (Axelson, 1999)

Multicultural Approach

(Axelson, 1999)

�Multiculture: Distinct group uniqueness and concepts that facilitate attention to individual differences (Gladding, 2009)

�Asperger's Syndrome is unique and diverse in symptom presentations and prognosis. Each person with AS has unique strengths, deficits, and needs.

�� Increasing cultural awareness means to see both the

positive and negative aspects of cultural differences – celebrating discovery

�Degrees of Awareness

Cultural Awareness

�Degrees of Awareness� My Way is the only way

� I know their way, but my way is better

� My way and Their way

� Our Way (shared meaning – participatory)

“Labels are for soup cans”

�

Let’s Travel ….

�� Asperger Syndrome (AS) is considered a pervasive developmental

disorder at the higher functioning end of the autism spectrum.

� It is characterized by sustained impairment in:

� Social interaction and

Discover Differences

� Social interaction and

� limited interests

� stereotyped and repetitive behavior (Stiefel, Shields, Swain, & Innes , 2008)

� In contrast to autism, there are no obvious delays in language or cognitive development, or in age appropriate self-help skills and adaptive behaviors though there are subtle impairments.

� More common in males then females

� Officially recognized in 1994 in the DSM-IV (Elkis-Abuhoff, 2004)

AspergersLeft Handed

NeurotypicalsRight Handed

Discover Differences

�

Neurotypicals are BetterFALSE

�

Aspergers and Neurotypicals: Social Differences

Men are from Mars Women are from Venus

Cat People41%

� Loner – More likely to be solitary

Dog people74%

� Pack animal

� Look for and reciprocate solitary

� Affection typically displayed on cats terms

� During stress/moments of fear cats tend to hide/isolate

� Cats wont learn from punishment – they will avoid the source (discover wants).

� Arduous to train

� Look for and reciprocate affection

� During stress/moments of fear dogs protect & approach

� Dogs can learn from punishment

� Easy to train

�

Common Traits & Characteristics

� socially awkward and clumsy

� naive and gullible

� unaware of others' feelings

� physically awkward in sports

� very accurate memory for details

� trouble understanding things � unaware of others' feelings

� unable to carry on conversation

� easily upset by changes

� literal in speech and understanding

� sensitive to loud sounds, lights, odors

� fixated on one subject or object

� trouble understanding things they have heard or read

� inappropriate body language & expression

� repetitive and irrelevant comments

� unusually loud, high or monotonous voice

� rock, fidget or pace while concentrating

��Ability to focus on both details as well as wholes

�Challenges with Central Coherence suggests that a person with Aspergers struggles with information

Central Coherence

Challenges with Central Coherence suggests that a person with Aspergers struggles with information processing leading to limitations with understanding the “big picture” and getting stuck on details.

�Weak central coherence leads to an inability to bring together various details from perception to make a meaningful whole AKA Gestalt

��Heightened focus on details rather than wholes

� Sensory struggles (hypersensitive sensory perception)

� Reading comprehension

Central Coherence

� Reading comprehension

� Theory of Mind

� Executive Functioning

� The inability to hold information in mind in order to use it later (poor working memory)

Central Coherence

�Assess current skills & needs in order to develop intervention plan

�Keep structural timetable

�Consistent is key – limits possible confusion or distress Coherencedistress

�Keep instructions simple & clear (resume style)

� Be aware of possible distractions

� Start simple/easy and work up

Tips

Group IGroup I

Group IIGroup II

�

Group I

�

Group II

��Challenges with Theory of Mind suggests that a

person with Aspergers has an arduous time gaining insight to the thoughts, feelings, and beliefs that are distinctive to others AKA perspective.

Theory of Mind

distinctive to others AKA perspective.

�An inability to recognize that other people have thought's, feelings and intentions that are different to one’s own and an inability to intuitively guess what these might be

�� Mind Blindness – difficulty conceptualizing and appreciating

the thoughts and feelings of others� Being able to relate to and understand the behaviors of others

(distinguishing whether someone's actions are intentional or accidental).

Theory of Mind

accidental). � Mind Blindness leads to Social Struggle� Poor communication skills� Difficulty with:

� Providing adequate information� Commenting on conversation� Organizing thoughts

� Inability to take another’s perspective, predict outcomes and decipher intentions

� Difficulty generalizing tasks to everyday situations

Theory of Mind

� Teach using visuals

� Learn Check-ins

� Educate purpose of Small talk & Practice (smart talk)

�Role PlayingMind

�Role Playing

� Feedback from peers

�Repetition, Repetition, Repetition

Tips

Theory of MindSocial Need Perspective

�� Challenges in Executive Functioning suggests that the cognitive

process makes it difficult to execute some practical living functions.

� Some examples:

Executive Functioning

� Some examples: � Organizing

� Planning

� Sequencing

� Getting tasks and/or activities started (initiating)

� Completing

� Changes/Transitions

� Focus

� Emotional Control

�� The way people monitor and control their thoughts

and actions (Carlson & Moses, 2001).

� Impairment or deficits in the higher-order processes


� Impairment or deficits in the higher-order processes that enable us to plan, sequence, initiate and sustain our Bx towards some goal, incorporating feedback and making adjustments along the way.

� Involves working memory, planning, cognitive flexibility and inhibitory control (language development).


�Visuals (i.e. lists, charts)

�Memory Techniques

� Technology

�Clear, Short & SweetFunctioning

�Clear, Short & Sweet

�Routine/Repetition

� Sleep

Tips

�

Awarness

Perception

�He/She doesn’t care –has No Empathy

Perspective

� Theory of Mind –Struggles with Mind

has No Empathy

�He/She doesn’t care –they never listen or pay attention

�He/She doesn’t care -lazy, and careless

Struggles with Mind Blindness

� Weak Central Coherence – Struggle with details vswhole (lost/confused/left behind)

� Executive Functioning –Struggle with organization, prioritizing

�

Awareness

�� Social Integration Model is rooted in the belief that it is the

responsibility of healthcare providers to prepare clients for life outside of Tx - designed to assist individuals in reaching the highest level of individual functioning possible.

� Emotional and psychological support are foundational. Focus on

Social Integration Model

� Emotional and psychological support are foundational. Focus on facilities is less important than how individuals act, behave and function outside of contained four walls. What really matters is how individuals function in the real world – that is the premise of the Social Integration Model.

� Social Integration Model immerses individuals into real life activities within the community.

� Recreational, social, cultural and life skills activities within the community with healthcare professionals form the core treatment interventions in the Social Integration Model

Within the community, licensed healthcare professionals observes clients in real life situations, and intervene, as appropriate, right there, on the spot and in the moment. These observations are then incorporated into the individuals


then incorporated into the individuals ongoing treatment plan.

How Does It Work

��Reduces being marginalized – Exposure for

individuals exposure for the community (Demystify)

Benefits of Social Integration

� Practicing coping skills in the moment with support from healthcare providers with immediate feedback.

� Social involvement with therapeutic support promotes effective participation in family, occupational, community and societal life.

�� The adaptation of the social integration model is to

help normalize behaviors. The philosophical goal is to assist individuals with Aspergers to achieve maximum social functioning so that they integrate

Real Life – Real Time – RelevantSocial Integration Model for Aspergers

maximum social functioning so that they integrate into their families and society at large and can thus enjoy those benefits of belonging and participating.

� Social and Life Skills development - through modeling, active training, exposure, experience, practice, repetition, etc.

�Kinesthetic

�


� Delivery of therapeutic services in the natural environment is embedded in the DNA of the Social

� learning to eat with proper manners at the table

� maintaining an organized personal space

� developing habits that establish proper ADLs in the DNA of the Social

Integration Model.

� Every activity must be looked at as an opportunity to provide therapeutic services that increase social functioning.

developing habits that establish proper ADLs

� learning to behave in proper fashion in public places such as stores & restaurants

� learning conflict resolution in public settings

� establishing an ability to function in high stimulus environments (i.e. theme parks & other recreational activities)

� developing healthy eating habits � developing healthy exercise

regimens

Experience, Exposure, Opportunity


��Hunter

� Sage

Colors of Development

Hunter– His Story

� Felt different

� Emotionally Reactive

� Poor sense of self

� Direct and Blunt

� Loves animals

� Unable to follow-through with goals Hunter– His Storythrough with goals

� Kicked out of multiple schools

� Unable to complete college

� Unable to go to a restaurant with family

“The basement couch is my future!”

�

Hunter Colors of Development

� Feels connected

� Lengthened the fuse

� Loves animals -� Loves animals -Career

� Follow through with goals

�Can go out to eat with family

Sage Her Story

� Poor perception of self

� Obsessive/Irrational thoughts

� Strong imagination

� High IQHer Story

� Gifted in languages

� Unable to pass class

� Multiple medical leaves

� Struggled with making friends

“I belong in a special farm for special people who get fake jobs to help them feel that they have purpose.”

�

SageColors of Development

� Acceptance (public mistakes)

� Positive self-talk "Being happy doesn't � Positive self-talk

� Strong imagination

� Tutoring – both ways

� In college (library)

� Friends – study dates

"Being happy doesn't mean that everything is perfect, it means that you've decided to look

beyond the imperfections"

��Cultural Awareness

� Social Differences

�DSM / Clinical Education

Another View

�DSM / Clinical Education

� Social Integration Model

� Examples of individual development

�Now …..

� Back to Purpose

�� Qualitative advantage in social interaction, as manifested by a majority of the

following:� peer relationships characterized by absolute loyalty and impeccable

dependability� free of sexist, "age-ist", or culturalist biases; ability to regard others at "face

value“

A Different Perspective …Celebrate Differences

value“� speaking one’s mind irrespective of social context or adherence to personal

beliefs� ability to pursue personal theory or perspective despite conflicting

evidence� seeking an audience or friends capable of: enthusiasm for unique interests

and topics;� consideration of details; spending time discussing a topic that may not be

of primary interest� listening without continual judgment or assumption� interested primarily in significant contributions to conversation; preferring

to avoid ‘ritualistic small talk’ or socially trivial statements and superficial conversation.

� seeking sincere, positive, genuine friends with an unassuming sense of humor

�� Cognitive skills characterized by at least four of the following:

� strong preference for detail over gestalt

� original, often unique perspective in problem solving

� exceptional memory and/or recall of details often forgotten or disregarded by others, for example: names, dates, schedules,


� exceptional memory and/or recall of details often forgotten or disregarded by others, for example: names, dates, schedules, routines

� avid perseverance in gathering and cataloguing information on a topic of interest

� persistence of thought

� encyclopedic or ‘CD ROM’ knowledge of one or more topics

� knowledge of routines and a focused desire to maintain order and accuracy

� clarity of values/decision making unaltered by political or financial factors

�� Additional possible features:

� acute sensitivity to specific sensory experiences and stimuli,

� for example: hearing, touch, vision, and/or smell

� strength in individual sports and games, particularly those


� strength in individual sports and games, particularly those involving endurance or visual accuracy, including rowing, swimming, bowling, chess

� “social unsung hero” with trusting optimism: frequent victim of social weaknesses of others, while steadfast in the belief of the possibility of genuine friendship

� increased probability over general population of attending university after high school

� often take care of others outside the range of typical development

��Become Culturally Aware

�Educate and Share with others (key stakeholders)

Enrich Yourself

stakeholders)

�Self Explore (who needs Tx – video game ex)

�Practice (Our Way)

�The Ode to the Autistic Man by Scott LentineTry to understand the challenges that I face

I would like to be accepted as a human in all placesWhere I will end up in life I don’t knowBut I hope to be successful wherever I go

I would like to expand my social skills in lifeMaking new friends would be very nice

Enrich Yourself

Making new friends would be very nice Stand proud for the autistic man

For he will find a new fanI hope to overcome the odds I face today

Increased acceptance will lead me to a brighter day By the age of 20, I will have made tremendous strides

I know in the future, life will continue to be an interesting rideI have made new friends by the year

I will be given tremendous respect by my family and peersI hope to get noted for bringing the issue of autism to the common man

So that autistic people can be accepted in this great landStand proud for the autistic man

For he will find a new fanI hope to overcome the odds I face today

Increased acceptance will lead me to a brighter day

“Strangers in a new culture see only what they know” – Unknown

Become Aware …. Discover

�� Organizations

� Advancing Futures for Adults with Autism� Center for Autism and Related Disabilities� Autism Speaks� CARD� AANE

Resources

� AANE� Websites

� www.aane.org� www.tonyattwood.com� www.pasadenavilla.com� www.autisminternetmodules.org� www.autismvotes.org� www.centerforautism.com

� Books� The Complete Guide to Asperger's Syndrome by Tony Attwood� Asperger's Syndrome: A Guide for Parents and Professionals by Tony

Attwood� A Self-Determined Future with Asperger's Syndrome: Solution Focused

Approaches by E. Veronica Bliss and Genevieve Edmonds� Look Me in the Eye: My Life with Aspergers by John E. Robison

�� American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders (4th ed.). Washington, DC.� Attwood, Tony. "The Discovery of ."Morning News. 11.3 (1999): n.

page. Web. � Garcia, Winner. "Three Core Deficits of Aspergers

References

� Garcia, Winner. "Three Core Deficits of AspergersSyndrome." www.sacramentooasis.com. Sacramento AspergersSyndrome Information and Support. Web

� Attwood, Tony. "What is Asperger's Syndrome?."WWW.tonyattwood.com. Tony Attwood, n.d. Web.

� Pasadena, . "Social Integration Model."WWW.pasadenavilla.com. Appleton Creative , n.d. Web.

� Quappe, Stephenie. "What is Cultural Awareness, anyway? How do I build it?." Adler, Organizational Behavior. (1991): n. page. Web. 21 Mar. 2013. <www.culturosity.com>.

bridging the social gap & connecting cultures

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